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Purpose: This study aimed to evaluate the impact of lidocaine-saline solution compared to saline alone for washing out the lumpectomy cavity, focusing on its effect on acute postoperative pain—a prevalent and significant concern among patients undergoing breast surgery. Methods: In this comparative study, 72 patients scheduled for lumpectomy surgery were randomly assigned to either the lidocaine-saline or saline group. The lidocaine-saline group was administered a washout of the lumpectomy cavity with 2 % lidocaine at a dosage of 1.75 mg/kg in 0.9 % normal saline, whereas the saline group received a washout with an equivalent volume of 0.9 % normal saline. We recorded the participants' basic characteristics, heart rate, blood pressure, the incidence and intensity of pain (measured by the visual analogue scale), and the usage of postoperative analgesics. Results: The two study groups did not differ significantly in their basic characteristics, heart rate and blood pressure. The saline group had significantly higher pain intensity than the lidocaine-saline group at 30 min after surgery (4.61 vs. 2.88, P

Interface bonding between calcium silicate hydrate (C–S–H) and epoxy is of critical importance for C–S–H/epoxy composites that are extensively utilized in the civil engineering, and yet it is susceptible to saline solution or elevated temperature. Herein, molecular dynamics is applied to explore the debonding mechanisms of epoxy from C–S–H surface under the coupling effect of water, ions, and temperature. Aqueous environment is the prerequisite for temperature and ions to influence interface bonding. At dry state, temperature elevation promotes the structure relaxation of C–S–H/epoxy interface, which optimizes the coordination structure at interface and increases interface energy. At wet state, on the contrary, temperature elevation aggravates the weakened effect of water molecules on interface bonding. The dynamics of epoxy molecules changes from the feature of solid state into fluid state. Water molecules and Na+ act in the same way at the interface. Both compete for active sites of epoxy molecules and C–S–H surface, which interferes the formation and stability of the bonds between C–S–H and epoxy molecules. As compared with water molecules, ions play larger roles in weakening interface bonding.

Background: Intralesional injection of sodium thiosulfate has emerged as a promising therapy for calcinosis cutis, but to our knowledge there are no randomized controlled trials evaluating its efficacy as a treatment. Objective: Conduct a prospective, double-blinded investigation of intralesional sodium thiosulfate versus normal saline in the treatment of dystrophic calcinosis cutis. Methods: This prospective pilot study injected normal saline or sodium thiosulfate at 0.1 mL/cm2 into lesions at baseline and at 1- and 2-month follow-up. Subjects were followed for a total of 12 weeks. An in-person Physician Global Assessment score was assigned by the injecting physician at each visit and was repeated by an independent observer. Results: Of 4 subjects who completed the study, only 1 experienced improvement in the size and Physician Global Assessment score of the lesion. By 3-month follow-up, there was no difference between the average size of the treatment and control lesions (P = .39). Limitations: This was a small single-center study with limited demographic diversity and a short follow-up period. Only dystrophic calcinosis cutis subjects were included, and subjects received only 3 monthly injections of sodium thiosulfate. Conclusions: With only 1 positive response, our results highlight the need for further study of sodium thiosulfate treatment for dystrophic calcinosis.

We propose a dataset to investigate the relationship between the fill level of bottles and tiny machine learning algorithms. Tiny machine learning is represented by any Artificial Intelligence algorithm (spanning from conventional decision tree classifiers to artificial neural networks) that can be deployed into a resource constrained micro controller unit (MCU). The data presented has been originally collected for a joint research project by STMicroelectronics and Sesovera.ai. This article describes the recorded image data of bottles with 4 levels of filling. The bottles contain sodium chloride sterile liquid for intravenous administration. One subject of investigation using this dataset could be the classification of the liquid fill level, for example, to ease continuous human visual monitoring which may represent an onerous time-consuming task. Automating the task can help to increase the human work productivity thus saving time. Under normal circumstances, human visual monitoring of the saline level in the bottle is required from time to time. When the saline liquid in the bottle is fully consumed, and the bottle is not replaced or the infusion process stopped immediately, the difference between the patient's blood pressure and the empty saline bottle could cause an outward rush of blood into the saline.

This study aimed to investigate the causes, outcomes, and compensation amounts of saline-induced perioperative burns, a rare but entirely preventable event. Saline-induced burns pose a significant risk to patients, and understanding the factors associated with such incidents is crucial for improving patient safety. Previous studies highlighted the use of hot saline bags and solution during medical procedures as a potential cause of these burns. A retrospective analysis of cases involving perioperative saline-induced burns was conducted using the Westlaw and Lexis Nexis legal databases. Eight relevant cases were identified and analyzed to determine the causes, outcomes, and compensation amounts. Hot saline bags used for positioning and hot saline solution were identified as the primary causes of saline-induced burns. Out of the eight cases analyzed, four resulted in a favorable verdict for the plaintiff, three cases were settled, and one case was in favor of the defense. Compensation amounts ranged from no monetary compensation to over one million dollars. This study highlights the need for increased awareness among medical professionals regarding the risks associated with saline-induced burns, and the importance of implementing guidelines for the safe use of hot saline bags and solution. Together these measures can hopefully mitigate the occurrence of these preventable incidents, improve patient safety, and reduce medicolegal exposure., (Copyright © 2023 Elsevier Ltd and ISBI. All rights reserved.)

Hydrofluoric acid (HF) is a ubiquitous industrial chemical that is particularly hazardous because of the potential for systemic effects and the induction of severe cutaneous necrosis after contact with the skin. Minimizing skin injury requires decontaminating the affected area promptly with an emergency rinsing solution. Few experimental studies have objectively characterized rinsing solutions such as Diphoterine (DP). Here we develop an ex vivo pigskin model to study and compare the efficacy of rinsing solutions as initial decontaminating agents to stop the progression of skin lesions after HF splashing. The pigskin model shows an immediate local response to HF at varying concentrations and exposure times. We then exposed the pigskin biopsies to 3.75% HF for 1 min and rinsed them with different solutions, including water, 0.9% NaCl solution (saline), 10% calcium gluconate (CaG), Hexafluorine (HXF), and DP. We found DP to be a more effective agent for decontaminating HF lesions than water, saline, and CaG. DP had a similar efficacy as HXF, an emergency rinsing solution used specifically for decontaminating HF-exposed skin. This study shows that skin exposed to HF must be treated quickly from the first minute of exposure., Competing Interests: Declaration of Competing Interest Dr. Legault and Dr. Pichette report research funding from Rio Tinto Aluminium and from LASEVE from University of Quebec at Chicoutimi, and they reported no biomedical financial interests or potential conflicts of interest. Mrs Bélanger, M.Sc. and Mr Gauthier, MD reported no biomedical financial interests or potential conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

Competing Interests: ASM and CAP report grants (all paid to their institutions) from Orion Pharma, Abbott Nutrition International, B Braun Medical, CSEM, Edwards Lifesciences Services, Kenta Biotech, Maquet Critical Care, Omnicare Clinical Research, Nestlé, Pierre Fabre Pharma, Pfizer, Bard Medica, Abbott, Anandic Medical Systems, Pan Gas Healthcare, Bracco, Hamilton Medical, Fresenius Kabi, Getinge Group Maquet, Dräger, Teleflex Medical, GlaxoSmithKline, Merck Sharp and Dohme, Eli Lilly and Company, Baxter, Boehringer-Ingelheim, Aseptuva, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, and Nycomed, outside of the submitted work.

Study Objectives: Tranexamic acid (TXA) is an antifibrinolytic that is widely used to reduce surgical bleeding. However, TXA occasionally causes seizures and the risk might be especially great after neurosurgery. We therefore tested the hypothesis that TXA does not meaningfully increase the risk of postoperative seizures within 7 days after intracranial tumor resections., Design: Randomized, double-blind, placebo-controlled, non-inferiority trial., Setting: Beijing Tiantan Hospital, Capital Medical University., Patients: 600 patients undergoing supratentorial meningioma resection were included from October 2020 to August 2022., Interventions: Patients were randomly assigned to a single dose of 20 mg/kg of TXA after induction (n = 300) or to the same volume of normal saline (n = 300)., Measurement: The primary outcome was postoperative seizures occurring within 7 days after surgery, analyzed in both the intention-to-treat and per-protocol populations. Non-inferiority was defined by an upper limit of the 95% confidence interval for the absolute difference being <5.5%. Secondary outcomes included incidence of non-epileptic complication within 7 days, changes in hemoglobin concentration, estimated intraoperative blood loss. Post hoc analyses included the types and timing of seizures, oozing assessment, and a sensitivity analysis for the primary outcome in patients with pathologic diagnosis of meningioma., Main Results: All 600 enrolled patients adhered to the protocol and completed the follow-up for the primary outcome. Postoperative seizures occurred in 11 of 300 (3.7%) of patients randomized to normal saline and 13 of 300 (4.3%) patients assigned to tranexamic acid (mean risk difference, 0.7%; 1-sided 97.5% CI, -∞ to 4.3%; P = 0.001 for noninferiority). No significant differences were observed in any secondary outcome. Post hoc analysis indicated similar amounts of oozing, calculated blood loss, recurrent seizures, and timing of seizures., Conclusion: Among patients having supratentorial meningioma resection, a single intraoperative dose of TXA did not significantly reduce bleeding and was non-inferior with respect to postoperative seizures after surgery., Registry Information: This trial was registered at clinicaltrials.gov (NCT04595786) on October 22, 2020, by Dr.Yuming Peng., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2023. Published by Elsevier Inc.)

Background: Using treatable traits as a management approach in bronchiectasis involves determining identifiable, clinically relevant, measurable and treatable problems to develop a management strategy in collaboration with the patient., Objective: To identify new treatable traits not previously reported in the literature and treatment strategies for new and existing traits that could be implemented in an outpatient clinic or community setting by an allied health professional or nurse in adults with bronchiectasis., Methods: A scoping review was conducted with searches of MEDLINE, CINAHL, AMED, Embase, Cochrane Central Register of Controlled Trials and PsycInfo. The search yielded 9963 articles with 255 articles proceeding to full text review and 114 articles included for data extraction., Results: Sixteen new traits were identified, including fatigue (number of studies with new trait (n) = 13), physical inactivity (n = 13), reduced peripheral muscle power and/or strength (n = 12), respiratory muscle weakness (n = 9) and sedentarism (n = 6). The main treatment strategies for new and existing traits were airway clearance therapy (number of citations (n) = 86), pulmonary rehabilitation (n = 58), inspiratory muscle training (n = 20) and nebulised saline (n = 12)., Conclusion: This review identifies several new traits in bronchiectasis and highlights the common treatments for new and existing traits that can be implemented in a treatable traits approach in an outpatient clinic or community setting by an allied health professional or nurse., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Study Objective: Administering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV)., Design: Patients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed., Setting: Operating room, post-anesthetic care unit, and general ward., Patients: In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study., Measurements: Blood pressure (BP), heart rate, PONV, visual analog scale (VAS)., Main Results: The Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups., Conclusions: Administering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil., Competing Interests: Declaration of Competing Interest The authors declare that no author has a conflict of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This review summarises some of my work on fluid and electrolyte balance over the past 25 years and shows how the studies have influenced clinical practice. Missing pieces in the jigsaw are filled in by summarising the work of others. The main theme is the biochemical, physiological and clinical problems caused by inappropriate use of saline solutions including the hyperchloraemic acidosis caused by 0.9% saline. The importance of accurate and near-zero fluid balance in clinical practice is also emphasised. Perioperative fluid and electrolyte therapy has important effects on clinical outcome in a U-shaped dose response fashion, in which excess or deficit progressively increases complications and worsens outcome. Salt and water overload, with weight gain in excess of 2.5 kg worsens surgical outcome, impairs gastrointestinal function and increases the risk of anastomotic dehiscence. Hyperchloraemic acidosis caused by overenthusiastic infusion of 0.9% saline leads to adverse outcomes and dysfunction of many organ systems, especially the kidney. Salt and water deficit causes similar adverse effects as fluid overload at the cellular level and also leads to worse outcomes. Serum albumin is shown to be affected mainly by dilution and inflammation and is not a good nutritional marker. These findings have been incorporated in the British consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) and National Institute for Health and Care Excellence (NICE) guidelines on intravenous fluid therapy in adults in hospital and are helping change clinical practice and improve outcomes., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: This systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator., Research Methodology: This review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses., Results: In total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning., Conclusion: This systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits., Implications for Clinical Practice: As recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Postoperative nausea and vomiting (PONV) is a major problem after surgery. Even with double prophylactic therapy including dexamethasone and a 5-hydroxytryptamine-3 receptor antagonist, the incidence is still high in many at-risk patients. Fosaprepitant, a neurokinin-1 receptor antagonist, is an effective antiemetic, but its efficacy and safety in combination antiemetic therapy for preventing PONV remain unclear., Methods: In this randomised, controlled, double-blind trial, 1154 participants at high risk of PONV and undergoing laparoscopic gastrointestinal surgery were randomly assigned to either a fosaprepitant group (n=577) receiving fosaprepitant 150 mg i.v. dissolved in 0.9% saline 150 ml, or a placebo group (n=577) receiving 0.9% saline 150 ml before anaesthesia induction. Dexamethasone 5 mg i.v. and palonosetron 0.075 i.v. mg were each administered in both groups. The primary outcome was the incidence of PONV (defined as nausea, retching, or vomiting) during the first 24 postoperative hours., Results: The incidence of PONV during the first 24 postoperative hours was lower in the fosaprepitant group (32.4% vs 48.7%; adjusted risk difference -16.9% [95% confidence interval: -22.4 to -11.4%]; adjusted risk ratio 0.65 [95% CI: 0.57 to 0.76]; P<0.001). There were no differences in severe adverse events between groups, but the incidence of intraoperative hypotension was higher (38.0% vs 31.7%, P=0.026) and intraoperative hypertension (40.6% vs 49.2%, P=0.003) was lower in the fosaprepitant group., Conclusions: Fosaprepitant added to dexamethasone and palonosetron reduced the incidence of PONV in patients at high risk of PONV undergoing laparoscopic gastrointestinal surgery. Notably, it increased the incidence of intraoperative hypotension., Clinical Trial Registration: NCT04853147., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment., Methods: Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05)., Results: There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05)., Conclusions: LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: This study aimed to identify possible products resulting from chemical interactions between calcium hypochlorite (Ca[OCl] 2 ) and other irrigants for endodontic use using electrospray ionization quadrupole time-of-flight mass spectrometry., Methods: The 5.25% Ca(OCl) 2 was associated with either 70% ethanol solution, distilled water, saline solution (0.9% sodium chloride), 5% sodium thiosulfate, 10% citric acid, 17% ethylenediaminetetraacetic acid (EDTA), or 2% chlorhexidine (CHX). The reaction ratio was 1:1 and the products obtained were analyzed by electrospray ionization quadrupole time-of-flight mass spectrometry., Results: The interactions between Ca(OCl) 2 and CHX generated an orange-brown precipitate, without identification of para-chloroaniline and between Ca(OCl) 2 and sodium thiosulfate, a milky-white precipitate. Furthermore, when the oxidizing agent was associated with EDTA and citric acid, chlorine gas was released. As for the other associations, 70% ethanol, distilled water, and saline solution, no precipitation or gas release occurred., Conclusions: The orange-brown precipitate occurs due to the chlorination of guanidine nitrogens, and the milky-white precipitate is due to the partial neutralization of the oxidizing agent. The release of chlorine gas occurs due to the low pH of the mixture, which results in the rapid formation and decomposition of chlorine. In this context, an intermediate rinsed with distilled water, saline solution, and ethanol between Ca(OCl) 2 and CHX, citric acid, and EDTA seems to be appropriate to prevent the formation of by-products when these irrigants need to be used in the canal. Furthermore, if it is necessary to use sodium thiosulfate, a larger volume of the solution must be used compared to that used for the oxidizing solution., (Copyright © 2023 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Background: Patients with chronic kidney disease (CKD) undergoing coronary angiography (CAG) are at high risk of contrast-associated acute kidney injury (CA-AKI) and mortality. Therefore, there is a clinical need to explore safe, convenient, and effective strategies for preventing CA-AKI., Objectives: This study sought to assess whether simplified rapid hydration is noninferior to standard hydration for CA-AKI prevention in patients with CKD., Methods: This multicenter, open-label, randomized controlled study was conducted across 21 teaching hospitals and included 1,002 patients with CKD. Patients were randomized to either simplified hydration (SH) (SH group, with normal saline from 1 hour before to 4 hours after CAG at a rate of 3 mL/kg/h) or standard hydration (control group, with normal saline 12 hours before and 12 hours after CAG at a rate of 1 mL/kg/h). The primary endpoint of CA-AKI was a ≥25% or 0.5-mg/dL rise in serum creatinine from baseline within 48 to 72 hours., Results: CA-AKI occurred in 29 of 466 (6.2%) patients in the SH group and in 38 of 455 (8.4%) patients in the control group (relative risk: 0.8; 95% CI: 0.5-1.2; P = 0.216). In addition, the risk of acute heart failure and 1-year major adverse cardiovascular events did not differ significantly between the groups. However, the median hydration duration was significantly shorter in the SH group than in the control group (6 vs 25 hours; P < 0.001)., Conclusions: In CKD patients undergoing CAG, SH is noninferior to standard hydration in preventing CA-AKI with a shorter hydration duration., Competing Interests: Funding Support and Author Disclosures This study was funded by the Beijing Lisheng Cardiovascular Health Foundation (LHJJ20141751), Guangdong Provincial Science and Technology Project (2020B1111170011 and KJ022021049), and Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (No. Y0120220151), Multi-center study on key techniques for prevention, diagnosis, and treatment of high-risk coronary artery disease (DFJH2020026). The funders were not involved in study design, data collection, analysis, interpretation, or reporting. All authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Intraoperative wound irrigation (IOWI) is an important step in preventing surgical site infection (SSI). This study compared the effectiveness of saline with gentamicin versus povidine-iodine (PI) as IOWI solutions in preventing SSI in open spine surgery., Methods: It is a prospective comparative study. Patients who had noninstrumented open spine surgery were randomized into 2 groups. Group A and B patients had their surgical wounds irrigated with saline containing gentamicin solution and dilute PI solution, respectively. Both groups were assessed for the occurrence of SSI., Results: A total of 80 patients, divided into 2 groups of 40 each completed the study. Overall, the SSI rate was 17.5% for patients in the normal saline containing gentamicin group (A) and 2.5% for those in the dilute PI group (B), this difference was statistically significant (P = 0.025). The cervical and thoracic spine regions have the same SSI rate (7.1% and 0%, respectively) in both groups. However, in the lumbosacral region, the SSI rate was 31.6% in A and 0% in B, this was statistically significant (P = 0.006). The isolated organisms in patients with SSI were staphylococcus species (42.86% of SSI in A and 0% in B) and pseudomonas species (42.86% of SSI in group A and 100% in group B), and this difference was profound in the lumbosacral spine region (P = 0.008)., Conclusions: IOWI with 3.5% dilute PI solution is more efficacious in preventing SSI and has wider microbial coverage compared to normal saline containing gentamicin solution as IOWI fluid in noninstrumented open spine surgery., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Available studies have shown the involvement of nitric oxide (NO) in the processes that lead to neurodegeneration in Parkinson's disease (PD). Also, the use of inhibitors of the inducible isoform of NO-synthase (iNOS) promotes neuroprotection and attenuates dopamine (DA) loss in experimental models of Parkinsonism. In addition, NO also appears to be involved in cardiovascular changes in 6-hydroxydopamine (6-OHDA)-induced Parkinsonism. The current study aimed to evaluate the effects of iNOS inhibition on cardiovascular and autonomic function in animals that were subjected to Parkinsonism by the administration of 6-OHDA., Materials and Methods: The animals underwent stereotaxic surgery for bilateral microinfusion of the neurotoxin 6-OHDA (6 mg/mL in 0.2% ascorbic acid in sterile saline solution) or vehicle solution for the Sham group. From the day of stereotaxis until the day of femoral artery catheterization, the animals were treated with the iNOS inhibitor, S-methylisothiourea (SMT; 10 mg/kg; i. p.) or saline solution (0.9%; i. p.) for 7 days. The animals were divided into four groups: Sham-Saline, Sham-SMT, 6-OHDA-Saline, and 6-OHDA-SMT. Subsequent analyses were performed on these four groups. After 6 days, they underwent catheterization of the femoral artery, and 24 h later, mean arterial pressure (MAP) and heart rate (HR) were recorded. Another group of animals (the 6-OHDA and Sham groups) was assessed for aortic vascular reactivity after 7 days of bilateral infusion of 6-OHDA or vehicle, in which cumulative concentration-effect curves (CCEC) were made for phenylephrine (Phenyl), acetylcholine and sodium nitroprusside (NPS). Also, CCEC in the presence of Nw-nitro-arginine-methyl-ester (l-NAME) (10-5 M), SMT (10-6 M), and indomethacin (10-5 M) blockers were made., Results: The effectiveness of the 6-OHDA lesion was confirmed with the reduction of DA in 6-OHDA animals. However, treatment with SMT could not reverse the loss of DA. Concerning the baseline parameters, SBP and MAP values were lower in 6-OHDA animals compared to their Sham control, with no effect of treatment with SMT. In the analysis of SBP variability, a decrease in variance, the VLFabs component, and the LFabs component were observed in the 6-OHDA groups when compared to their controls, regardless of treatment with SMT. It was also observed that intravenous injections of SMT resulted in an increase in BP and a decrease in HR. However, the response was not different between the Sham and 6-OHDA groups. In vascular function, there was a hyporeactivity to Phenyl in the 6-OHDA group, and when investigating the mechanisms of this hyporeactivity, it was seen that the Rmax to Phenyl increased with incubation with SMT, indicating that iNOS could be involved in the vascular hyporeactivity of animals with Parkinsonism., Conclusion: Thus, the set of results presented in this study suggests that part of the cardiovascular dysfunction in animals subjected to 6-OHDA Parkinsonism may be peripheral and involve the participation of endothelial iNOS., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The domestic cat is a highly prolific species; thus, reproductive control is crucial to reducing feral cat overpopulation. This study aimed to assess the effect of a commercially-available GnRH vaccine for swine on suppressing sperm production in male cats. Twelve sexually mature tomcats were randomly divided into two groups. Treated cats (n = 9) received a GnRH vaccine (Improvac, Zoetis Belgium SA, 0.5 mL sc) twice 4 wk apart, and the control group (CON, n = 3) saline solution (0.5 mL sc). Reproductive parameters and blood samples were recorded every 2 wk, from 6 wk before vaccination until 24 wk after the first dose. Day 0 of the study was defined as the day of primary immunization with either the vaccine or saline solution. Serum testosterone concentrations of treated cats dropped to basal levels 6 wk after D0, while CON cats maintained serum testosterone concentrations between normal ranges during the study period. No differences were observed in pretreatment and CON seminal samples. However, a progressive decrease in seminal quality was observed in treated cats from wk 8 until the end of the study. By wk 24, sperm concentration and total sperm count decreased by 90%, motility decreased by 70%, and viability decreased by 60%. Moreover, testicular volume was reduced by 49%, and penile spines showed almost complete atrophy by the end of the study. Although treated cats showed a decrease in the hematocrit, erythrocyte count, and hemoglobin concentration, values were within the reference range for domestic cats. No differences were observed in the other hematological and biochemical parameters evaluated. Our results agree with previous immunocontraception studies in cats, showing that Improvac vaccination effectively reduced sperm quality, testicular volume, and serum testosterone concentration. Further studies should be carried out to define the Improvac long-term effect., Competing Interests: Declaration of competing interest The authors declared no potential conflicts of interest concerning this article's research, authorship, and/or publication., (Copyright © 2022. Published by Elsevier Inc.)

This work is aimed at the study at studying the influence of the interaction of solvate shells on the profiles of the IR spectra of sodium chloride solutions in the 2750-4000 cm -1 range. The IR spectra of distilled water and sodium chloride solutions were obtained with the limit (0.356 g per 100 g of water) and 50 % of the limit (0.178 g per 100 g of water) concentrations at a temperature of 21˚. Theoretical methods based on the use of the DFT approach with the XLYP exchange-correlation potential are used to calculate the profiles of the IR spectra of clusters containing 9 water molecules per one NaCl molecule at the limit concentrations of the solution. In the case when the cluster contained a NaCl molecule, the spectra were calculated for interacting and non-interacting solvate shells in which the number of H 2 O molecules varied from 3 to 6. The expansion of the experimental band profile on a basis containing the profiles of the theoretical bands made it possible to study the features of NaCl hydration with a change in the concentration of solutions. It was found that the IR spectrum band is formed mainly by interacting Na + and Cl - solvation shells, each containing 4 H 2 O molecules, while the ninth H 2 O molecule provides the bond between the solvated ions. As the salt concentration increases, the contribution of the solvation shells to the band profile increases too. The agreement reached in the positions and profiles of experimental and theoretical water bands at different solution concentrations substantiates the adequacy of the theoretical description of NaCl hydration. Theoretical studies explained the effect of a decrease in the band width, an increase in the peak intensity, and a shift of its maximum toward higher wavenumbers with increasing solution concentration., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The current study aimed to assess, for the first time, the effects of intramuscular injection of l-arginine (L-arg) on testicular hemodynamics, echogenicity, and plasma concentrations of testosterone, total antioxidant capacity, and nitric oxide (NO) in Ossimi rams. Twelve sexually matured heat-stressed rams were randomly assigned to one of two groups: the L-arg group (n = 6) received 5 mg/kg L-arg dissolved in 2 ml normal saline 0.9%, or the control group (n = 6) received merely 2 ml of normal saline 0.9%. Blood sampling, B-mode ultrasound assessment of the testicular parenchyma, and pulsed-wave Doppler ultrasound of the testicular artery for both right and left testis were performed immediately before 0 min and 1, 4, 24, 48, 72, and 168 h after L-arg or saline administration. In the L-arg group, resistive index (RI) and pulsatility index (PI) means were significantly lower compared to the control group at 4-168 h post-treatment. Plasma testosterone concentrations were higher (P < 0.05) at 4 h and onward in the L-arg treated compared to the control rams, the same for NO levels however its increase (P < 0.05) was observed as soon as 1 h post-treatment. In L-arg treated rams, NO concentrations were positively correlated to plasma testosterone concentrations (r = 0.7, p < .01), but negatively correlated to both RI and PI (r = -0.8 and -0.6, respectively, p < .01). In conclusion, l-arginine administration enhanced testicular blood flow and increased plasma testosterone and nitric oxide concentrations in heat-stressed rams., Competing Interests: Declaration of competing interest None of the authors have any conflict of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The objective of this study is to describe the technique and evaluate the clinical value of normal saline (NS) injection for expanding the anterior perirectal space during prostate cryoablation for prostate cancer (PCa) patients., Methods: PCa patients who received cryoablation between August 2014 and December 2019 were enrolled, and the technique of NS injection was adopted. The complications were evaluated. The prostate-specific antigen (PSA) nadir and biochemical progression-free survival (bPFS) were measured in localized PCa patients who received cryoablation as the primary treatment., Results: A total of 159 PCa patients were included. Among 147 patients with the data of anterior perirectal space, the median (interquartile range [IQR]) distance of estimated iceball edge beyond the prostatic capsule was 8.3 (7.0-10.0) mm. No cases of urethrorectal fistula were reported; 29 patients developed urinary retention and 25 patients presented scrotal edema. All complications below Clavien-Dindo grade IIIb disappeared within 7 weeks after surgery. Urinary incontinence was reported in 6 patients. Among localized PCa patients, the median (IQR) follow-up time was 56.5 (36.0-73.5) months. The estimated 5-year bPFS was 82.3% overall, 82.8% for low-to intermediate-risk PCa patients, and 82.1% for high-risk PCa patients. For 52 patients received cryoablation alone, the median (IQR) PSA nadir was 0.147 (0.027-0.381) ng/mL., Conclusions: The technique of NS injection for expanding the anterior perirectal space during cryoablation surgery could avoid urethrorectal fistula and might benefit localized PCa patients with lower PSA nadir and longer bPFS., (Copyright © 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Nicorandil, an adenosine triphosphate-sensitive potassium channel agonist and nitric oxide donor, is a coronary vasodilator used to treat ischemia-induced chest pain, but it's potential cardioprotective benefits during open heart surgery have not been thoroughly investigated. The study objective was to assess the impact of nicorandil on postoperative ventricular dysfunction and end-organ injury in an established experimental model of open-heart surgery with cardiopulmonary bypass (CPB) and cardioplegic arrest. We hypothesized that nicorandil would attenuate myocardial ischemia-reperfusion (IR) injury, preserve ventricular function, and reduce end-organ injury., Methods: Rabbits were cannulated for CPB, followed by 60 min of aortic cross-clamp (ACC) with cold cardioplegic arrest, and 120 min of recovery after ACC removal. Nicorandil (or normal saline vehicle) was given intravenously 5 min before ACC and continued throughout the recovery period. Left ventricular developed pressure (LVDP), systolic contractility (LV + dP/dt), and diastolic relaxation (LV -dP/dt) were continuously recorded, and blood and tissue samples were collected for measurement of oxidant stress (OS), inflammation, apoptosis, and organ injury., Results: Nicorandil significantly attenuated IR-induced LV dysfunction compared to saline control (R-120: LV + dP/dt: 1596 ± 397 vs. 514 ± 269 mmHg/s, p = 0.010; LV -dP/dt: -1524 ± 432 vs. -432 ± 243 mmHg/s, p &lt; 0.001; LVDP: 55 ± 11 vs. 22 ± 5 mmHg, p = 0.046). Furthermore, nicorandil inhibited IR-induced increases in OS, inflammation, apoptosis, and organ injury., Conclusions: Nicorandil exhibits myocardial protection by attenuation of IR-induced LV dysfunction associated with OS, inflammation, apoptosis, and organ injury. Nicorandil should be explored further as a potential therapeutic strategy for limiting global IR injury during open-heart surgery in humans., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The objectives of the present study were to estimate the number of colonies forming units (CFU) from penile mucosa and semen, the effect of two antiseptic solutions used to flush the preputial cavity to reduce the bacterial counts from those sites, and compare them. Six clinically healthy bulls between 15 and 16 mo old declared satisfactory potential breeders were used. A prospective, randomized, and controlled cross-over design was performed, in which each bull was first sampled from the penile mucosa and semen without treatment (control group) and 24 h later, after antiseptic preputial flushing (treated group). In the treated group, the preputial area was cleaned, the preputial hair was cut, urination was stimulated, prepuce area was scrubbed twice, and the preputial cavity was flushed with either 1% of povidone-iodine solution (POI; 500 mL) or 0.05% chlorhexidine digluconate (CHG; 500 mL), maintained for 10 min. Then, the preputial cavity was emptied and flushed with 500 mL of sterile saline solution. Next, the accessory sexual glands were massaged per rectum. Finally, protrusion, erection, and ejaculation were obtained by electroejaculation, and samples from penile mucosa and semen were collected for microbiological culture. The number of CFU was determined for each sample by enumerate total aerobic bacteria using Standard Plate Surface Count cultured for 48 h. In the first replicate, half of the bulls were treated with CHG, and the other half were treated with POI. After 58.8 ± 5.3 days (x ± SD) of wash-out period, the treatments were reverted, and the same protocols were applied again. In the control group, the median number of CFUs from the penile mucosa was 750,000 (range from 60,000 to 1,800,000) and the median number of CFUs in semen was 8,000,000 (700,000-45,000,000). The CFU in semen was higher than the penile mucosa (P = 0.005). Both antiseptic solutions reduced the median number of CFUs on the penile mucosa to 915 (P = 0.002) and in semen to 1,680 (P = 0.002). The antiseptic effect on the penile mucosa was higher for CHG solution (490) than for POI solution (6,650; P = 0.05). The antiseptic effect on semen of CHG was also greater (200) than for the POI solution (31,000; P = 0.05). It can be concluded that the median number of CFU was higher in semen compared with penile mucosa, and flushing the preputial cavity either with 0.05% CHG or 1% POI maintained for 10 min reduced the number of CFUs from penile mucosa and semen. The level of antiseptic activity was higher for CHG than for POI., Competing Interests: Declaration of competing interest All authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Automobile exhaust-derived particulate matter 2.5 (PM2.5) can cause spermatogenic cell damage, potentially resulting in male infertility. This study uses male prepubertal Sprague Dawley (SD) rats to explore the molecular mechanisms by which automobile exhaust-derived PM2.5 causes spermatogenic cell damage and induces spermatogenesis dysfunction during sexual maturity by disrupting the mitochondrial unfolded protein response (UPR mt ) in spermatogenic cells. Male prepubertal SD rats were randomly divided into four groups: control (intratracheal instillation of normal saline), low-dose PM2.5 (5 mg/kg), high-dose PM2.5 (10 mg/kg), and PM2.5 10 mg/kg +Vit (100 mg/kg of vitamin C and 50 mg/kg of vitamin E). The rats were treated for four weeks, with five consecutive treatment days and two non-treatment days, followed by cohabitation. Testicular and epididymal tissues were harvested for analysis. The mitochondria in spermatogenic cells were observed under an electron microscope. UPR mt -, oxidative stress-, and apoptosis-related markers in spermatogenic cells were examined. Spermatogenic cell numbers and conception rate declined significantly with increasing PM2.5 dose, with their mitochondria becoming vacuolated, swollen, and degenerated to varying degrees. The apoptosis of spermatogenic cells was abnormally enhanced in PM2.5 exposed groups compared to the control group. Spermatogenic cell numbers of conception rate gradually recovered, mitochondrial damage in spermatogenic cells was alleviated, and spermatogenic cell apoptosis was significantly reduced after vitamin intervention. In addition, protein levels of superoxide dismutase 1 (Sod1), nuclear factor erythroid 2-related factor 2 (Nrf2), and B-cell lymphoma 2 (Bcl-2) were significantly lower, while those of Bcl2-associated X apoptosis regulator (Bax), cleaved caspase 3 (Casp3), and cytochrome c (Cyt-c) and malondialdehyde (MDA) levels were significantly higher in the high-dose PM2.5 group than in the control group. The levels of UPR mt -related proteins C/EBP homologous protein (Chop), heat shock protein 60 (Hsp60), and activating transcription factors 4 (Atf4) and 5 (Atf5) were higher in the low-dose PM2.5 group, lower in the high-dose PM2.5 group, and gradually recovered in PM2.5 10 mg/kg +Vit group. Our results show that exposure to automobile exhaust-derived PM2.5 induces oxidative stress responses, leads to post-sexual maturation UPR mt dysfunction and mitochondrial impairment, and abnormally enhances spermatogenic cell apoptosis in prepubertal rats, resulting in male infertility., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

This study investigated the effect of BPF on male sexual performance and the quality of the offspring. Eighty (80) Male Wistar rats (n = 10 per group) were randomised into normal saline-treated control and control recovery, BPF varied doses (low, medium, and high), and BPF varied doses recovery (low, medium, and high) groups. The study was terminated after 28 days of BPF oral administration. The animals were sacrificed after 24 h from the last dose, while those in the recovery groups were allowed to recover for another 28 days before being sacrificed. BPF administration was found to impair sexual performance, as shown by a significant decrease in frequencies (mount, intromission, and ejaculation frequencies) and an increase in latencies (mount, intromission, and ejaculation latencies). This was accompanied by a significant decrease in plasma LH, FSH, testosterone, dopamine, acetylcholinesterase, nitric oxide, and penile cyclic guanosine monophosphate (cGMP) level. The level of plasma oestrogen and prolactin were significantly increased following BPF administration. BPF also reduced the sperm count, morphology, viability, and motility. Furthermore, BPF reduced fertility success and index, litter size, litter weight, and offspring survival rate. These toxic effects of BPF were dose-dependent and were not reversed by withdrawal following 28 days of recovery. This study concluded that BPF disrupts sexual competence and offspring quality by suppressing the hypothalamic-pituitary-gonadal axis and mediating oestrogen-induced hyperprolactinemia. These events were associated with reduced fertility index and success, poor semen quality, and reduced offspring survival rate. The observed toxic effects of BPF were dose-dependent and not reversed by cessation of BPF exposure., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)

Background: During hypoxia or acidosis, S-nitrosoglutathione (GSNO) has been shown to protect the cardiomyocyte from ischemia-reperfusion injury. In a randomized double-blinded control study of a porcine model of paediatric cardiopulmonary bypass (CPB), we aimed to evaluate the effects of 2 different doses (low and high) of GSNO., Methods: Pigs weighing 15-20 kg were exposed to CPB with 1 hour of aortic cross-clamp. Prior to and during CPB, animals were randomized to receive low-dose (up to 20 nmol/kg/min) GSNO (n = 8), high-dose (up to 60 nmol/kg/min) GSNO (n = 6), or normal saline (n = 7). Standard cardiac intensive care management was continued for 4 hours post-bypass., Results: There was a reduction in myocyte apoptosis after administration of GSNO (P = .04) with no difference between low- and high-dose GSNO. The low-dose GSNO group had lower pulmonary vascular resistance post-CPB (P = .007). Mitochondrial complex I activity normalized to citrate synthase activity was higher after GSNO compared with control (P = .02), with no difference between low- and high-dose GSNO., Conclusions: In a porcine model of CPB, intravenous administration of GSNO limits myocardial apoptosis through preservation of mitochondrial complex I activity, and improves pulmonary vascular resistance. There appears to be a dose-dependent effect to this protection., (Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Emerging evidence supports the superiority of balanced crystalloids such as Lactated Ringer's (LR) compared to normal saline but concerns for the development of hyperkalemia have limited its use. Although LR inherently contains potassium, there exists a paucity of evidence to suggest that LR could potentiate hyperkalemia. To address this, we evaluated the effect of LR on serum potassium in patients with reduced kidney function who are at risk of developing hyperkalemia., Methods: We conducted a single-center, retrospective cohort-based observational clinical study that included 293 clinical encounters who were hospitalized with an estimated glomerular filtration rate (eGFR) of < 30 ml/min/1.73m 2 , at the time of hospital admission. Subjects must have received a minimum of 500 ml of LR continuously during the admission. Only those with a minimum of one lab report within 24 hours prior to-, and post-LR administration that reported serum measurements of potassium, glucose, and bicarbonate levels were included. Other potential risk factors for developing hyperkalemia including medication, tube feeds, potassium supplements, and red blood cell transfusion during or within 24 hours after LR administration were recorded., Results: Serum potassium prior to LR use was highly correlated and predictive of the serum potassium after LR use [P < 0.0001; Odds Ratio 6.77 (3.73 - 12.28)]. Sixteen encounters (5%) developed de-novo hyperkalemia following LR use. No significant positive correlation between the amount of LR administered and the development of hyperkalemia was found., Conclusions: LR use was not independently associated with the development of hyperkalemia in patients with reduced kidney function., Competing Interests: Declaration of Competing Interest G.C. Cutter reports grants from the National Institutes of Health; and serves on data and safety monitoring boards of Astra-Zeneca; Avexis Pharmaceuticals; Biolinerx; Brainstorm Cell Therapeutics; Bristol Meyers Squibb/Celgene; CSL Behring; Galmed Pharmaceuticals; Mapi Pharmaceuticals LTD; Merck; Merck/Pfizer; Opko Biologics; Neurim; Novartis; Ophazyme; Sanofi-Aventis; Reata Pharmaceuticals; Teva pharmaceuticals; VielaBio Inc.; National Heart, Lung, and Blood Institute (Protocol Review Committee); National Institute of Child Health and Human Development (OPRU oversight committee); has received compensation for consulting or advisory board service from Antisense Therapeutics; Biodelivery Sciences International; Biogen; Genzyme; Genentech; GW Pharmaceuticals; Immunic; Klein-Buendel Incorporated; Medimmune/Viela Bio; Medday, Merck/Serono; Neurogenesis LTD; Novartis; Osmotica Pharmaceuticals; Perception Neurosciences; Recursion/Cerexis Pharmaceuticals; Regeneron; Reckover Pharmaceuticals; Roche; SAB Biotherapeutics; TG Therapeutics; and is president of Pythagoras Inc. - a private consulting company located in Birmingham, AL. D.V. Rizk reports grants from the National Institutes of Health; other support from IGA Nephropathy Foundation of America; a grant from Achillion Pharmaceuticals, Inc.; a grant from Reata Pharmaceuticals, Inc.; a grant from Calliditas Pharmaceuticals AB; a grant from Retrophin, Inc.; a grant from Pfizer, Inc.; equity in Reliant Glycosciences, LLC.; and personal fees from Visterra, Inc. and Novartis Pharmaceuticals outside the submitted work during the conduct of the study. A. Zarjou reports grants from the National Institutes of Health; and is supported by a Southern Society of Clinical Investigation (SSCI) Research Scholar Award. A. Rajasekaran and N. Bade have no conflicts of interest to declare., (Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Introduction: Open reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial., Material and Methods: Sixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated., Results: Both groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups., Conclusion: There is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: Burkholderia gladioli has been associated with infections in patients with cystic fibrosis, chronic granulomatous disease, and other immunocompromising conditions. The aim of this study was to better depict the outbreak of healthcare-associated bacteremia caused by B. gladioli due to exposure to contaminated multidose vials with saline solutions., Methods: An environmental and epidemiologic investigation was conducted by the Infection Prevention and Control Team (IPCT) to identify the source of the outbreak in three Croatian hospitals., Results: During a 3-month period, 13 B. gladioli bacteremia episodes were identified in 10 patients in three Croatian hospitals. At the time of the outbreak, all three hospitals used saline products from the same manufacturer. Two 100-ml multidose vials with saline solutions and needleless dispensing pins were positive for B. gladioli. All 13 bacteremia isolates and two isolates from the saline showed the same antimicrobial susceptibility patterns and pulsed-field gel electrophoresis profile, demonstrating clonal relatedness., Conclusion: When an environmental pathogen causes an outbreak, contamination of intravenous products must be considered. Close communication between the local IPCT and the National Hospital Infection Control Advisory Committee is essential to conduct a prompt and thorough investigation and find the source of the outbreak., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Endocardial catheter ablation for ventricular tachycardia (VT) may fail owing to the inability to deliver transmural lesions. Saline-enhanced radiofrequency (SERF) ablation uses a needle-tip catheter that is placed at varying depths into the myocardial tissue and heated saline solution is injected along with radiofrequency power (RF), creating fully transmural lesions. We report the first in-human SERF ablation for VT in Canada., Methods: Twenty-five patients with ischemic and nonischemic cardiomyopathy, with recurrent monomorphic drug-refractory VT who had failed a prior catheter ablation underwent SERF ablation in 3 different centres in Canada. After a voltage map, the mapping catheter was replaced with the needle-tipped ablation catheter, which was located perpendicular to the myocardium and extended either 6 or 8 mm into the tissue. Sterile saline solution was infused at a flow rate of 10 mL/min and at 60 °C, and 20-50 W RF was used., Results: Baseline left ventricular ejection fraction was 33.3 ± 8.6%, mean age was 69.5 ± 6.4 years; 92% were male. From 43 clinical VTs induced, 42 were ablated and 266 SERF lesions were delivered (10.6 ± 4.9 per patient). Of the 42 treated clinical VTs, 41 VTs (98%) were noninducible and 24 patients (96%) had their VT eliminated. At 6 months' follow-up, 42% of patients were free from VT and there was a 73% reduction in shocks., Conclusions: SERF ablation is feasible and permits control of symptomatic monomorphic VT in drug-refractory patients with a prior failed ablation., (Copyright © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

The Essure® permanent contraceptive implant, comprised of four alloys (nickel-titanium, 316L stainless steel, platinum-iridium, and tin-silver solder) and Dacron (PET) fibers, has been approved for use in the US for about two decades. However, little has been published on this implant's biomaterials performance, and as this implant gains interest in terms of in vivo performance, methods of implant post-retrieval storage also need to be assessed. This study investigated the electrochemical properties and ion release profile of Essure® during storage in phosphate buffered saline (PBS), 10 mM H 2 O 2 /PBS, a simulated inflammatory solution, and 10% neutral buffered formalin (NBF) to investigate the corrosion behavior and metal ion release. First, a galvanic test method was used to measure the galvanic interactions between alloys within the device. Second, an ion-release study over 107 days was performed. Ions were measured using inductively-coupled plasma mass spectrometry and the implants were assessed using digital optical microscopy, scanning electron microscopy, and energy dispersive x-ray spectrometry. The tin-silver (SnAg) solder continuously corroded in PBS and H 2 O 2 /PBS. In the presence of H 2 O 2 , nickel and titanium ions were released from the nickel-titanium (NiTi) coil, whereas release of these ions was minimal in PBS alone. Overall, corrosion of the SnAg solder, which holds the NiTi and 316L SS together, was significant in both PBS and H 2 O 2 /PBS and may result in loss of connection of the NiTi and 316L stainless steel portions of the implant. Storage in NBF exhibited very low corrosion rates for all alloys and low levels of ion release were observed indicating that formalin storage minimally affects the implant's corrosion status. STATEMENT OF SIGNIFICANCE: The Essure® device is an FDA premarket-approved female permanent sterilization device containing four different metal alloys and poly(ethylene terephthalate) polymer fibers. Significant concerns related to this device have been raised by the FDA since its introduction in 2002. This study is the first published in vitro work to specifically assess the corrosion mechanisms in this multi-alloy device and the role of different solution environments, including formalin storage, inorganic physiological saline and a simulated inflammatory condition. Significant evidence of corrosion of the tin-silver solder is documented, the release of Ni and Ti under simulated inflammatory conditions, and the relative inertness of storage of these implants in neutral buffered saline is presented. The tin-silver corrosion corroborates recent clinical evidence of tin corrosion products in tissues adjacent to these devices in vivo., Competing Interests: Declaration of competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. CA has no disclosures. JLG receives research support through Clemson University from Bayer and DePuy Synthes. JLG receives consulting income from Bausch and Lomb, Smith and Nephew, Stryker and Zimmer Biomet. JLG receives royalties from Syracuse University. JLG is Editor-in-Chief of the Journal of Biomedical Materials Research – Part B and is a member of the Council of the Society For Biomaterials., (Copyright © 2022 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Introduction: 5% of children are born with auricular deformities. Permanent recontouring can be achieved through splinting during early infancy. Beyond this time, splinting is ineffective, and patients require surgical correction. Neonatal cartilage malleability is hypothesized to be secondary to retained maternal estrogens, increasing hyaluronic acid concentration. In this article, we evaluate the efficacy of local estrogen treatments for the nonsurgical recontouring of mature auricular cartilage., Methods: Ears of New Zealand rabbits were folded and splinted and then were randomly assigned to an experimental group, n = 10 (injected estrogen, topical estrogen, saline, or untreated). Treatment ears received injected estrogen or saline twice weekly or topical estrogen daily for 4 weeks. Two weeks post-treatment, splints were removed, and ear angles were measured. Biopsies were taken for histologic and mechanical analysis, and systemic estrogen levels were assayed., Results: Ear angles stabilized by 9 days post-splinting. Topical estrogen led to a significantly smaller resting angle (121.6° ± 13.5°) compared with saline and control (135.9° ± 11.2° and 145.3° ± 13.0°, respectively). Injected estrogen led to the most pronounced angle decrease (64.5° ± 35.3°). Ears injected with estrogen also showed a significant increase in cartilage thickness. Hyaluronic acid concentration was increased in both estrogen treatment groups compared with saline. At 3 weeks post-treatment, there was no significant differences in the elastic modulus of the cartilage or serum estrogen levels among the groups., Conclusion: Results show the potential result of local estrogen treatment to achieve a stable nonsurgical remodeling of mature auricular cartilage. Further study is needed to evaluate the molecular mechanism and improve the transdermal estrogen delivery to optimize treatment regimen., Competing Interests: Conflicts of Interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Recent studies suggest that balanced fluids improve inpatient outcomes compared to normal saline. The objective of this study was to obtain insights into clinicians' knowledge, attitudes and perceived prescribing practices concerning IV isotonic fluids and to analyze perceived prescribing in the context of actual prescribing., Methods: This study, conducted at a single center (Medical University of South Carolina), included 1) a cross-sectional survey of physicians and advanced practice providers (APPs) (7/2019-8/2019) and 2) review electronic health record (EHR) claims data (2/2018-1/2019) to quantify the prescribing patterns of isotonic fluids., Results: Clinicians perceived ordering equivalent amounts of normal saline and balanced fluids although normal saline ordering predominated (59.7%). There was significant variation in perceived and actual ordering across specialties, with internal medicine/subspecialty and emergency medicine clinicians reporting preferential use of normal saline and surgical/subspecialty and anesthesia clinicians reporting preferential use of balanced fluids (p < 0.0001). Clinicians who self-reported providing care in an intensive care unit (ICU) reported more frequent use of balanced fluids than non-ICU clinicians (p = 0.03). Actual prescribing data mirrored these differences. Clinicians' self-reported use of continuous infusions (p = 0.0006) and beliefs regarding the volume of fluid required to cause harm (p = 0.003) were also associated with self-reported differences in fluid prescribing. Clinician experience, most clinical considerations (e.g., indications, contraindications, barriers to using a specific fluid), and fluid cost were not associated with differential prescribing., Conclusions: Persistent normal saline utilization is associated with certain specialties, care locations, and the rate and volume of fluid administered, but not with other clinical considerations or cost. These findings can guide interventions to improve evidence-based fluid prescribing., Competing Interests: Conflicts of Interest The authors have no conflicts of interest to disclose., (Copyright © 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

The effectiveness of dimple surface texturing via picosecond pulsed laser processing for reducing wear loss was investigated using two types of titanium alloys, β-type Ti-29Nb-13Ta-4.6Zr (TNTZ) and α+β-type Ti-6Al-4V ELI (Ti64). The two alloys showed different modes of wear against zirconia. As the sliding distance increased, the wear loss was observed to increase for Ti64, but not necessarily for TNTZ. The wear debris of Ti64 acted as abrasive particles, but that of TNTZ easily adhered to the surface, and the adhered wear debris turned into a hard wear-protective layer. Therefore, the dependence of wear loss on the sliding distance for these two titanium alloys could be attributed to the difference in the roles of wear debris between each titanium alloy and zirconia. Further, depending on this difference in wear mode, the effect of dimple surface texturing on the wear was found to be different in Ti64 and TNTZ. As the dimples can trap the wear debris, they are effective for reducing wear in Ti64 but are detrimental in TNTZ., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The poultry industry has attempted to improve carcass chilling efficiency, meat quality, and product safety. The purpose of this research was to investigate the effects of subzero saline chilling on carcass chilling time and microbial safety. Eviscerated tom turkeys were randomly picked from a local turkey processing plant and subjected to chilling in one of the 3 chilling solutions: 1) 0% NaCl/0.5°C (ice slurry control), 2) 4% NaCl/-2.41°C, and 3) 8% NaCl/-5.08°C. The turkey carcasses in subzero saline solutions were chilled more efficiently and reduced the chilling time over the carcasses in ice slurry solution. No significant difference was observed for carcass chilling yield and fillet cooking yield regardless of chilling method (P > 0.05). The number of mesophilic aerobic bacteria (MAB), Escherichia coli (E. coli), and total coliform cells were significantly reduced in the carcasses chilled in subzero saline solutions over the icy control, except MAB in 4% NaCl/-2.41°C (P < 0.05). Based on these results, the chilling of turkey carcass in subzero saline solution appears to improve carcass chilling efficiency and bacterial reduction, especially Gram-negative bacteria such as E. coli and total coliforms., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)